2017-02-21_REPORT - M1982126

• Permit No: M1982126
• IBM Index Class Name: Report
• Doc Date: 2/21/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: Crowley County
• Annual Report Year: 2017
• Media Type: D
• Archive: No

Page 5 of 5

Division records indicate the following permittee/landowner contact information (blank fields indicate that we do not have
information on record). If this information is blank or not current , please type or print current contact information:
Permittee Contact:

T.E. Allumbaugh
Permittee Company:

Crowley County
Address:

603 Main St. Ste. 2
Ordway, CO 81063

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:

Carol Mumm
Company:

Crowley County
Address:

110 E 6th St
Ordway, CO 81063

Phone Number:

[phone]
Fax Number:
Email Address:
Inspection Contact:

Carol Mumm
Company:

Crowley County
Address:

110 E 6th St
Ordway, CO 81063

Phone Number:

[phone]
Fax Number:
Email Address:

I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site operations are
being conducted in accordance with the Division approved mining and reclamation plans.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date

M-AF-04